Marker

nineteen

It didn't take laurie as long as she'd feared to get back to the OCME, but once again, the ride in the taxi markedly aggravated her abdominal distress. Marvin had been waiting for her, and she immediately posted the police custody case, which turned out to be therapeutic. By the time she finished the autopsy, the pain had vanished and in its stead was a vague sensation of pressure. As she changed out of her scrubs, she pressed the area with her fingers. In contrast to what had happened that morning, palpating the area made it feel worse. As confused as ever, she went into the toilet stall to see if she was spotting, but she wasn't.

Laurie went up to her office and stared at her phone. Once again, she thought about calling Laura Riley but had the same reluctance. She didn't even know the woman, and she hated to start out the relationship by bothering her on a weekend with a problem that could probably wait until Monday. After all, Laurie had been having the symptoms for a number of days. The sudden appearance of the few drops of blood was the only aspect that was truly different, and that seemingly had stopped.

Annoyed with herself for her indecisiveness, Laurie switched to thinking about calling Calvin. She could update him on Roger and give him a heads-up on the police custody case. She'd found extensive trauma to the prisoner's larynx, with the implication that excessive force had been used. Such cases were invariably politically challenging and Calvin would need to be apprised. Yet there was no apparent pressure from the media, and the toxicology had yet to be done. Laurie decided it could all wait until Monday unless Calvin took it upon himself to call.

Instead of making any phone calls, Laurie decided to spend some serious time with the charts from Queens and then Roger's lists. She felt she owed it to him, since he had, in a way, sadly given his life for the cause.

The first thing that she noticed was that the St. Francis charts were significantly different from the General's. Whereas the Manhattan General was a tertiary teaching hospital, St. Francis was a mere community institution. There were no interns or residents writing notes, so the charts were much skimpier. Even the attending doctor's notes and the nurses' notes were shorter, which made them much easier to go through.

As she expected from having read the forensic investigators' reports on each of the cases, the demographics matched those of the General. The victims were all relatively youthful, and had died within twenty-four hours of elective surgery. They were also all healthy, compounding the tragedy.

Laurie then remembered Roger saying that he'd discovered that the General cases were all relatively recent subscribers to AmeriCare. Turning to the biographical data section of the chart she was currently examining, Laurie saw that it was the same. She quickly checked the other five Queens charts. All of the patients had been AmeriCare subscribers for less than a year. Two of them had been subscribers for only two months.

Laurie pondered this curious fact and wondered if it was significant. She didn't know, but she took out a ruled pad of paper and wrote: all victims recent AmeriCare subscribers. Beneath that, she wrote: all victims within twenty-four hours of anesthesia; all victims on IV's; all victims young to middle-aged; all victims healthy.

Laurie looked at her list and tried to think of any other ways the victims had been related. Nothing came to mind, so she put the pad aside and went back to the charts. Although she knew the General cases had occurred in various parts of the hospital with many on the surgical floor, she didn't know about the Queens cases. Quickly, she determined that it was similar, with cases spread around the hospital.

Since the Queens charts were considerably thinner, Laurie was more tempted to look at every page, and with one chart, she found herself even reading the admission orders, which were standardized on a printed form. They described prepping the operative site, proscribing anything by mouth after midnight, and various routine laboratory studies. As Laurie's eyes ran down the list, she stopped on a test she didn't recognize. It was grouped with blood tests, so she assumed it was a blood test. It was called MASNP. She'd never heard of a test called MASNP. She wondered if NP stood for nuclear protein, but if it did, what did MAS stand for? She didn't know, but if she was right about the meaning of NP, then the test might be some kind of immunological screen.

Switching to the back of the chart where all the laboratory test results were appended, Laurie searched for the result. She didn't find it. Although she found all the other test results, there was no MASNP result.

With her curiosity piqued, Laurie looked in the other Queens charts. Each one had an order for an MASNP, but no result. It was exactly the same with the charts from General: Each chart had the order, but no results.

Laurie reached for her ruled pad and wrote: All victims had an MASNP ordered but no MASNP result; what's an MASNP?

Thinking about laboratory tests reminded Laurie of the short run of EKG in Sobczyk's chart taken by the resuscitation team. She shuffled through the charts until she found the right one. It was easy, since it still had her ruler sticking out. Laurie opened the chart, unfolded the segment, and reread the Post-it note she'd written to herself to show the segment to a cardiologist. Putting Sobczyk's chart aside but open to the EKG, she then checked to make sure none of the other charts had any EKG associated with the resuscitation attempts. She hadn't remembered seeing any, but she wanted to be certain.

"I hope I'm not interrupting anything," a voice said.

Laurie turned around. Jack was standing in the doorway. Instead of his usual mildly sardonic expression, his face reflected concern.

"You look awfully busy," he added.

"It's best I stay busy," Laurie responded. She reached over for Riva's chair and pulled it over next to her desk. "I'm glad to see you. Come on in and sit down."

Jack lowered himself into the seat and scanned Laurie's desk. "What are you doing?"

"I wanted to make certain the Queens cases were the equivalent of those at the General. They are, to a surprising degree. I also found something curious. Are you acquainted with a blood test called MASNP? I assume it is an acronym, but I've never heard of it."

"Me neither," Jack said. "Where did you see it?"

"It's part of the standardized preoperative orders in all these cases," Laurie said. She picked up a chart at random and showed the order form to Jack. "It's in every chart. I guess it's part of AmeriCare's established routine, at least at these two hospitals."

"Interesting," Jack commented. He shook his head. "Did you look in the back to see what kind of units the results are recorded in? That might be a clue."

"I tried that, but I couldn't find any results."

"Not in any one of the charts?"

"Nope. Not one!"

"Well, I'm sure we can clear that up on Monday by asking one of the forensic investigators to look into it."

"Good suggestion," Laurie said. She made herself another Post-it note. "There is something else curious about all these victims. Without exception, every one of them is a relatively new subscriber to AmeriCare, having joined the plan within the last year."

"Now that's a cheery thought, considering that's what we are."

Laurie gave a half laugh. "I hadn't thought of that."

"The plan is growing so fast, I imagine a fair percentage of subscribers falls into that group."

"True, but it still seems odd to me."

"Anything else of note?" Jack asked.

Laurie glanced around at the charts scattered across her desk. "There is one other thing." She picked up Sobczyk's chart with the short run of EKG recording folded out, and handed it to Jack. "Does this tracing ring any bells with you? It was taken by the resuscitation team the moment they got to the patient and just before the patient flatlined."

Jack glanced at the squiggles, too embarrassed to admit he'd never been much good at EKG interpretation in even the best of circumstances. He had decided early in medical school that he was going into ophthalmology, and he didn't pay too much attention to skills that he wasn't going to need.

With a shake of his head, Jack handed the chart back to Laurie. "If I was forced to say something, I'd say that it looks to me as if the conduction system of the heart is failing, but that's obvious with the way the complexes are spread out. But you shouldn't be asking me. My advice would be to show it to a cardiologist."

"That's my plan," Laurie said, taking the chart back and putting it with the others.

"What about Roger's lists?" Jack asked. "Have you had time to go over them?"

"Not yet. I had to do the police custody case first, so I've only been here for half an hour or so. I'll spend some time with the lists when I finish the charts. It's with the charts that I feel I can make the biggest contribution. There's got to be some piece of the pie I'm not seeing."

"You don't think it's random?"

"No. There's something that links these patients together, beyond what we already know."

"I'm not so sure. I think the cases are opportunistic with the victims being at the wrong place at the wrong time."

"Did you guys have any luck with Najah?"

"Yes and no," Jack said. "They picked him up all right, but he's not cooperating. He claims he's being discriminated against and victimized by racial profiling. They've got him in custody, but he won't talk. He's insisting on waiting for his attorney, who'll be up from Florida tomorrow for the arraignment."

"And the gun?"

"It's been sent to ballistics. But results won't be available for a while. In the meantime, I'm sure he'll be given bail."

"What's Lou's take on whether he's the man?"

"He's optimistic, especially given his behavior. Lou says if someone is innocent, they're happy to cooperate. Of course, Lou is only concentrating on who shot the nurse and Rousseau. He's not thinking about your series."

"What about you?"

"As I said, I like the idea he's an anesthesiologist. Given his training, he could be knocking these patients off in a way that would be hard for us to figure out. As for him shooting the nurse and Rousseau, that's equally circumstantial, since it's based merely on knowing he owned a nine-millimeter handgun. The problem is that there are a lot of those weapons out there."

"You don't think that whoever is killing the patients killed the nurse and Roger?"

"I'm not sure."

"I am," Laurie said. "It stands to reason. The nurse probably saw something suspicious. Her death occurred the morning after there were two additions to my series. As for Roger, he'd gone up in the hospital specifically to talk to people he thought were potential suspects. He could have confronted Najah. Maybe he even saw him in Pruit's room."

"Very good points," Jack conceded.

"I'm glad they arrested Najah," Laurie said. "If he's the one, he'll think twice about any more shenanigans while Lou is breathing down his neck, which means I'm going to sleep a little better tonight. In the meantime, I'm going to go over Roger's lists very carefully, in case he doesn't pan out."

Jack nodded several times that he agreed with Laurie's plan. There was a brief pause until Jack said, "I know it's a bit off-topic, but can we pick up where we left off last night?"

Laurie eyed Jack warily. As they had been talking, she'd noticed that his typical sardonic expression had gradually reappeared, which she couldn't help but feel was a bad sign now that he was suggesting turning the conversation to personal issues. Deep down, a combination of frustration and irritation begin to brew. With everything else going on, from guilt about Roger's death to the pressure in her lower abdomen, she was uninterested in weathering any more disappointment.

"What's the matter?" Jack asked, in response to Laurie's silence. Misinterpreting her hesitancy, he raised his eyebrows questioningly and superciliously added, "Is this still not the time or the place?"

"You got that right!" Laurie blurted, struggling for control in the face of Jack's tone. "The city morgue is hardly the place to discuss starting a family. And furthermore, to be honest with you, I suddenly realize I'm finished discussing it. The facts are pretty damn plain. I've made it clear how I feel, up to and including the new development of my pregnancy. What I don't know is how you feel, and I've got to know whether you're interested and capable of abandoning your self-absorbed grieving role. If that is what you want to tell me, then fine! Tell me! I'm sick and tired of discussing it, and I'm sick and tired of waiting for you to make up your mind."

"I can see this is definitely not the time or the place," Jack said with equal irritation. He stood up. "I think I'll wait until a more opportune circumstance."

"You do that," Laurie snapped.

"We'll be in touch," Jack said before walking out the door.

Laurie turned to her desk, cradled her head in her hands, and sighed. For a brief second she considered running after Jack, but even if she did, she wouldn't know what to say when she caught him. It was obvious he wasn't about to tell her what she wanted to hear. At the same time, Laurie questioned if she was being too pushy and demanding, especially since she'd not told him about her latest symptoms and the fear that she had yet to voice even to herself: the fear of a miscarriage, which would change everything all over again.

It was a little after four in the afternoon when David Rosenkrantz turned his car into the parking lot of the small commercial building where Robert Hawthorne had his office. In its previous life, the building had been a warehouse, but like much of the renovation in downtown St. Louis, it had been recycled. It now had an upscale restaurant on the first floor and boutique offices on the second. When Robert Hawthorne-or Mr. Bob, as he was known to his operatives-came to town, first to found a company called Adverse Outcomes and subsequently to set up Operation Winnow, he had found the space and thought it convenient, since it was close to the law offices of Davidson and Faber. David didn't know what the relationship was with the law firm, and he knew he wasn't supposed to ask. What he did know was that Robert was called over there on a fairly regular basis.

It wasn't often that David was in town, since it was his job to travel around to the various cities and check in on the field operatives and deal with them as necessary. This was not an easy job, considering the oddball characters they had functioning as independent contractors. At first David just put out fires, but now that he'd worked for Robert for more than five years, he'd been entrusted with recruitment as well. The recruitment was more fun and challenging. Robert would come up with the names from an old Army buddy who still worked in the Pentagon. They were mostly people who had worked in some sort of medical capacity in the military and who had been discharged less than honorably. David hadn't been in the military himself but could appreciate how the experience could affect people who were trying to return to civilian life, especially those who had seen any sort of combat. With Iraq grinding on, they had plenty of potential recruits. Of course, they also looked for people fired from civilian hospitals. Most of those tips came from people who were already embedded.

The door to the office was unmarked. David rapped on it with his knuckle in case Yvonne, the secretary, who was also Robert's live-in girlfriend, was in the back office. It wasn't a big operation. Robert, Yvonne, and David were the only employees, and for quite a few years, it had been just Robert and Yvonne.

There was a loud click of the locking mechanism as big-busted Yvonne opened the door. With her syrupy, southern-accented voice, she coquettishly invited David to step inside. Her syntax was interspersed with a lot of "honeys" and "dears," but David wasn't fooled. Despite the bleach-blond hair and the floozy affectations like spike heels and a short skirt, he knew that she worked out regularly with Robert and was proficient in tae kwon do. David felt sorry for anyone who might mistakenly decide after a few drinks to take advantage of her flirtatious behavior.

The office was simple. There were two desks, one in the front room and one in Robert's inner office, two computers, a couple of small tables, a few chairs, a file cabinet, and two couches. It was all rented.

"The ugly old boss is in the back room, honey," Yvonne whispered. "Now don't you go off and upset him, you hear?"

David had no intention of upsetting Robert. He knew something was up when Robert called him in. David had arrived back in town the night before, after a number of days on the West Coast, and was supposed to be enjoying some downtime.

"Sit down!" Robert said when David entered. Robert was at his desk with his legs crossed and his feet perched on the corner, hands behind his head. His Brioni jacket was tossed over the arm of the couch.

"You want any coffee, dear?" Yvonne questioned. There was an Italian espresso machine on the table in the front room.

David smiled and thanked Yvonne but declined. He looked at Robert, who had his lips pressed together in an expression of frustration. "I got some bad news a little while ago," Robert said. "It seems that our little Hungarian number in the Big Apple just can't control herself."

"Another shooting?" David asked.

"I'm afraid so," Robert said. "This time, it was one of the doctor administrators. The woman is a menace. She's good, but she's jeopardizing the whole operation."

"Are you sure she did it?"

"A hundred percent sure? No! Ninety-nine percent sure? Absolutely. Shootings follow her around like flies on a hunk of smelly cheese. Obviously, this kind of thing can't go on, so I'm afraid your little vacation has to be put on hold. Yvonne got you a reservation on a flight that gets in around ten-thirty."

"It's short notice. What about a gun?"

"Yvonne's taken care of that as well. You'll just have to make a detour on your way into the city."

"I don't remember her address."

"Yvonne's got that, too. Don't worry, we've thought of everything."

David got to his feet.

"You don't mind, do you?" Robert asked.

"No, I don't mind. I knew it was going to happen sooner or later."

"Yeah, I guess I did, too."

Outside of Laurie's rather dirty office window the gray day had faded into night as she'd pored over the charts yet another time, hoping to find some hidden piece of critical information. As had been the case on her previous readings, nothing jumped out at her. She had her Post-it notes to show the short strip of EKG to a cardiologist and to get the forensic investigators to clarify the nature of the MASNP test. Other than that, she didn't know what else to do.

She'd also carefully reviewed all of Roger's suspect lists, ranking them in order of their potential relevance. She still thought Najah was the most intriguing and most likely suspect, but the other seven individuals from various hospital departments who worked the night shift and who had transferred from St. Francis to the General around the critical time were almost equally interesting, especially since the entire group had easy access to the patient floors. The next list featured eight physicians whose hospital privileges had been canceled during the immediately preceding six-month period. She'd like to find out if possible what each one had done to warrant the disciplinary action.

Between studying Roger's lists and going over the charts for the final time, Laurie had thought about calling Jack. Although she felt her reaction to him earlier was understandable under the circumstances, she regretted it. She'd been far too precipitous and bitter, and she should have at least given him a chance to speak his mind, even if she suspected he was not going to say what she wanted to hear. At the same time, what she had said to him was unfortunately all too true. She was tired of his indecisiveness, which was the reason she'd moved out of his apartment when she had. Ultimately, Laurie decided not to call. It would have been like throwing salt on a wound. Instead, she decided to wait until morning, and if he hadn't called by then, she would call him.

Laurie stacked the hospital charts into two neat piles. Next to them, she put the notepad with her own list of how all the cases resembled one another. She put the CD with the digital records on top of the pad. She looked at her watch. It was quarter to seven, which she thought would be a good time to head back to her apartment. She would make herself a light supper before bed. Whether she would be able to sleep was another issue entirely. She hadn't wanted to go home earlier, for fear of becoming depressed. It had been better to stay busy all afternoon to keep from thinking about Roger's death, Jack's aggravating behavior, and her own looming problems.

Pushing back from the desk, Laurie was about to get up when she looked back at the CD. Suddenly, the idea occurred to her to look and see if there was a difference between the digital record and the hard-copy hospital chart-specifically, in respect to the unknown blood test. Maybe she could find a result, and if so, maybe she could figure out what the test was.

Pulling herself back to the desk, Laurie booted up her computer and inserted the CD, scrolling through the pages until she arbitrarily found herself at Stephen Lewis's laboratory values. The print was very small, and Laurie used her finger to run down the column on the left side of the page. Near the bottom, she found MASNP. Running her finger horizontally, she saw the result. It was "positive MEF2A."

Laurie absentmindedly scratched her scalp as she stared at the recorded result. There was no explanation. MEF2A didn't make any more sense to her than MASNP. It was like looking up the definition of an unknown word and finding an unknown synonym. Laurie took another Post-it from the dispenser and wrote down the result, followed by a question mark. In order to put the new Post-it with the others, which she had stuck to the wall behind her desk, she scooted her chair back and half stood, leaning forward with her hand outstretched.

A muffled cry of pain escaped from Laurie's lips. Instead of pasting the Post-it to the wall, both her hands went down on the surface of her desk to support her weight. She'd gotten a sudden, strong cramp in her lower abdomen, and for a few seconds, she held her position as well as her breath. Thankfully, the pain began to lessen, and Laurie slowly let herself sink back into her chair. She held herself stiffly, lest she aggravate whatever was going on inside her body.

A continuous low-grade discomfort had persisted in Laurie's abdomen following the autopsy on the police custody case. It had waxed and waned to a degree, but it had never entirely gone away. She had characterized it more as pressure than pain until she'd tried to place the new Post-it with the others.

Once the pain had lessened to the point that Laurie could breathe normally, she allowed herself to adjust her weight in her chair by sitting up straighten Thankfully, what had now become an ache stayed at the same tolerable level. Perspiration had appeared on her forehead, and she wiped it off with the back of her hand. She knew she was anxious, but she was surprised that she was anxious enough to perspire so freely. She wondered if she could have a fever, but didn't think so. Gingerly, she palpated her abdomen with a single finger. In contrast to previous occasions, there was now an area of definite tenderness, which seemed ominous to her. As she had noted earlier, it was exactly the location where the pain of appendicitis occurred.

With hesitation, Laurie slowly got to her feet. It had been the sudden motion of half standing a few minutes earlier that had brought on the current episode, and she was eager to avoid a repeat. Luckily, there was no reoccurrence. Her perspiration was another matter. That had actually gotten worse.

Cautiously, Laurie took a few steps out of her office and into the hallway while continuing to support herself with her hand against the wall. The pain remained bearable. With gathering confidence, she walked slowly down the length of the corridor to the ladies' room. Inside, she got some toilet tissue and wiped herself. The spotting had reappeared, and there was more blood than there had been earlier. She knew she didn't have appendicitis.

With gathering anxiety, Laurie retraced her steps back to her office and returned to her chair. She eyed the phone. She was still hesitant to call Dr. Riley, though now she felt she had little choice. The spotting ruled out appendicitis, and along with the location of the pain, suggested a possible ectopic pregnancy, which was far more serious than a mere threatened miscarriage. Finally, she reluctantly picked up the phone and called Laura Riley's office number. When the operator answered, Laurie gave her name and direct-dial number. Thinking it might expedite the callback, she included her M.D. title and said she needed to talk with the doctor. She said it was an emergency.

As Laurie put the receiver back down, she noticed a new sensation: vague shoulder discomfort. It was so mild that she wondered if she was imagining it, yet it added to her already considerable anxiety. If it was real, it suggested the ominous development of peritoneal irritation. To test the possibility, Laurie carefully pushed in on her abdomen with her index finger, then suddenly took her hand away. She grimaced with a fleeting stab of pain. What she had felt was called "rebound tenderness," and it also suggested peritoneal irritation, which now made her worry that not only might she have an ectopic pregnancy, but that it might have already ruptured. If so, it was a true medical emergency for which time could be a critical factor. She could be hemorrhaging internally.

The phone's harsh ring interrupted her obsessing, and she snapped the receiver up to her ear. She was relieved when Dr. Riley identified herself. Laurie could tell she was on a cell phone and in a public place. Loud conversation could be heard in the background.

Laurie began by apologizing for calling on a Saturday night and said that she had resisted because she worried it was a bad way to start out a professional relationship, but she believed she truly had no choice. Laurie went on to describe her symptoms in detail, including the rebound tenderness. She admitted she'd had discomfort prior to speaking with her on the phone the previous day, but had forgotten to mention it and had thought it could wait until her scheduled visit the following Friday.

"First of all," Laura said when Laurie had finished, "there's no need to apologize. In fact, I would have preferred you call sooner. I don't want to alarm you, but it we should consider an ectopic pregnancy until we can rule it out. You might be bleeding internally."

"I thought as much," Laurie admitted.

"Are you still diaphoretic?"

Laurie felt her brow. It was damp with perspiration. "I'm afraid so."

"What's your pulse, approximately? Is it fast or normal?"

Using her shoulder to hold the phone, Laurie felt her pulse at her wrist. She knew it had been fast earlier, and she wanted to be certain it had remained so. "It's definitely on the fast side," she admitted. She had hoped the sweating and the rapid heartbeat had been due to her anxiety, but Laura's questions had made her acknowledge that there could be another explanation: She could be going into shock.

"Okay," Laura said in a controlled, businesslike voice. "I want to see you in the emergency room at the Manhattan General Hospital."

Laurie felt a shiver descend her spine at the thought of being a patient at the General. "Could we pick another hospital?" she questioned.

"I'm afraid not," Laura said. "It's the only hospital where I have privileges. Besides, they are fully equipped if we have to be aggressive. Where are you at the moment?"

"I'm in my office at the Office of the Chief Medical Examiner."

"On First Avenue and Thirtieth Street?"

"Yes."

"And where is your office in the building?"

"It's on the fifth floor. Why do you ask?"

"I'm going to send an ambulance."

Good God! Laurie thought. She didn't want to ride in an ambulance. "I can take a taxi," she suggested.

"You are not going to take a taxi," Laura stated unequivocally. "One of the first rules about being a patient in an emergency medical situation, a rule which is particularly hard for doctors to accept, is that you must follow orders. We can argue about the necessity later, but right now we are not taking any chances. I'm going to send an ambulance ASAP, and I will meet you in the ER. Do you know your blood type?"

"O positive," Laurie said.

"See you in the emergency room," Laura said and disconnected.

With a shaking hand, Laurie hung up the phone. She felt shell-shocked. Upheavals were becoming the norm. In a single day she'd been forced to identify a friend's corpse and now face the terrifying prospect of a medical emergency and possibly surgery at a hospital where a suspected serial killer was killing patients like her. The only consolation was that the most likely suspect was in custody.

Laurie snatched up the phone. She'd been reluctant to call Jack for a variety of reasons, but with this new development, her hand was forced. She needed his support, she needed him as an ombudsman or guardian in the hospital if she did end up having emergency surgery.

The phone rang once, then twice. "Come on, Jack!" Laurie urged. "Answer it!" The phone rang again, and Laurie knew he wasn't there. As she suspected, after the next ring, his answering machine picked up. As Laurie waited to leave a message, she felt a wave of resentment wash over her. It seemed uncanny how Jack managed to irritate her in so many different ways. Undoubtedly, he was out on his neighborhood basketball court, pretending he was a teenager. Laurie knew she was being unreasonable, but she couldn't help it. She was actually angry that he wasn't there. Although she knew it was an unfair comparison, she couldn't help but think that had Roger not been killed, he would have been available.

"A major problem has come up," Laurie said when it was time for her to speak. "I need your help again. At the moment, I am waiting for an ambulance to take me to the Manhattan General. Dr. Riley thinks I might have a ruptured ectopic pregnancy. On the plus side, it will mean that the pressure will be off you, but on the negative side, I'll be facing emergency surgery. I need you to be there. I don't want to become part of my own series. Please cornel"

After pressing the disconnect button, Laurie dialed Jack's cell phone. She went through the same process, leaving a similar message in hopes he'd get one or the other. Then she pushed away from the desk with the idea of getting her coat before heading down to the basement level, where she expected the ambulance to arrive. As she stood up, she kept her hand pressed against her lower abdomen, hoping to avoid another severe cramp. Instead, she heard ringing in her ears and felt a wave of dizziness.

The next thing Laurie was aware of was voices, particularly the voice of a man seemingly talking on the telephone. He was saying something about the blood pressure being low but steady, the pulse at one hundred, and the abdomen being slightly tense. Laurie realized her eyes were shut, and she opened them. She was on the floor of her office, facing up at the ceiling. A female EMT was busily taping an IV line against her left arm. A male EMT was standing to the side while speaking on his cell phone. Behind him, she recognized Mike Laster. Alongside Laurie was a collapsed gurney with an IV pole.

"What happened?" Laurie asked. She started to get up.

"Easy," the female EMT said, placing her hand on Laurie's chest. "You just had a little fainting episode. But everything is okay. We're going to be getting you out of here in two seconds."

The male EMT snapped his phone shut. "All right, let's go!" He walked around behind Laurie's head and insinuated his hands beneath Laurie's back and into her armpits. The woman went to her ankles. "On three," the man said, and then quickly counted.

Laurie felt herself lifted over onto the gurney. The EMTs quickly secured her with straps, raised the gurney to waist-height, and jockeyed it out into the corridor.

"How long was I unconscious?" Laurie questioned. She'd never fainted before. She had no recollection of falling to the floor.

"It couldn't have been for very long," the woman said. She was at the foot pushing, while the man was at the head, pulling. Mike walked alongside.

"Sorry about this," Laurie said to Mike.

"Don't be silly," Mike responded.

They took the elevator down to the basement level. As they passed the mortuary office, Laurie saw the evening tech, Miguel Sanchez, standing in the doorway. Laurie waved self-consciously. Miguel waved back.

The gurney bumped across the morgue's concrete floor, past the security office, and out onto the loading dock. The ambulance was parked next to one of the Health and Hospital's mortuary vans. Laurie thought of the irony that she was going out the same way the bodies came in.

Once in the ambulance, the female EMT inflated a blood-pressure cuff around Laurie's right upper arm.

"What is it?" Laurie asked.

"It's fine," the woman said, although she reached over and opened the IV a little more.

For Laurie, the ride over to the Manhattan General Hospital was surprisingly rapid. She'd felt detached enough to close her eyes. She could hear the siren, although it seemed as if it were in the distance. The next thing she knew, the doors of the ambulance were flung open, and she was rolled out into bright light.

The emergency room was typically chaotic, but she didn't have to wait. She was whisked into the depths and directly into the acute care section. As she was being transferred onto an examination table, Laurie felt a hand grip her forearm. Laurie turned and found herself gazing up into the face of a youthful woman dressed in scrubs, complete with a hood.

"I'm Dr. Riley. We are going to be taking good care of you. I want you to relax."

"I'm relaxed," Laurie responded.

"Since we've not met before tonight, I need to ask if you have any medical problems, whether you are taking any medication, or whether you have any allergies."

"No to all of those questions. I've been blessed with very good health."

"Good," Laura said.

"Wait a second," Laurie said. "There is something I wanted to mention to you. I've recently been tested positive for the BRCA1 marker."

"Have you seen an oncologist about it?"

"Not yet."

"Well, I don't think that is going to influence what we need to do in this situation. Let me give you the game plan. First, we'll do a rapid culdocentesis, which is to confirm if you have any blood in the space behind your uterus. It's done with a needle through the apex of your vagina. It sounds worse than it is. You'll feel a pinch, but that's about all."

"I understand," Laurie said.

True to her word, Laura quickly did the procedure, with little discomfort to Laurie. The result was positive.

"This pretty much makes the decision about surgery for us," Laura said. "My biggest concern is that you are continuing to hemorrhage into your abdominal cavity. We've got to stop that. We also will need to give you some blood. Do you understand everything that I'm saying?"

"I do," Laurie said.

"I'm sorry you've had to experience a problem like this. I want to make certain you don't think it is your fault. Ectopic pregnancies are more common than people realize."

"There is something in my past that may have contributed. In college, I had an episode of pelvic inflammatory disease associated with an IUD."

"That may or may not have contributed," Laura said. "Meanwhile, is there anyone you would like us to call?"

"I've already called the person I'd like to be here," Laurie said.

"Okay, I'm going up to the surgery floor to make sure everything is ready. I'll see you in a few minutes."

"Thank you again. I'm sorry if I've ruined your Saturday night."

"What are you talking about? Getting you back to normal is going to make my Saturday night."

For a few minutes, Laurie was left by herself. She felt curiously detached, as if the whole episode involved someone else. She could hear telltale evidence of dramas unfolding in neighboring rooms, and saw people dash by the open doorway on various urgent errands.

Laurie felt lucky to have Laura Riley as her doctor, and was indebted to Sue for recommending her. With the kind of confidence and professionalism that Laura projected, Laurie wasn't as fearful about the upcoming surgery as she would have imagined. She knew she needed it, with the growing fullness in her abdomen and the general weakness the blood loss caused. Her only real worry was the fear of being victimized by SADS after the surgery and becoming a member of her own series, but she put the thought out of her mind. Instead, she thought about Jack and wondered when he would get her message. There was some concern that he was upset enough at her not to come in. If that were to happen, Laurie had no idea what she would do, so she put that thought out of her mind as well.